CASE 3: Unresectable Hepatocellular Carcinoma

Dale P is a 61-year-old Jamaican-American male from Houston, Texas, with a history of HCV infection and cirrhosis, who works in corporate cell-phone sales.

In February of 2012 the patient presented with upper right quadrant discomfort; CT scan showed the presence of a 4.1 Ã— 3.9-cm mass consistent with HCC in the setting of cirrhosis; he was referred to the multidisciplinary team for further assessment.

Initial assessment showed a MELD score of 7 and Child Pugh A class

The patient was not considered appropriate for transplant based on prior history of successfully treated renal cancer (4 years prior) and patient declining to pursue a transplant evaluation

Medical history notable for heavy alcohol use and substance abuse approximately 30 years ago, stroke in mother, deep vein thrombosis in father

Other medical history included nonresponse to pegylated interferon and ribavirin for HCV 5 years earlier; current medications included antihypertensives and aspirin